Cupertino Project Safety Review

• Document No.

• Project Name/Location

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of Individual(s) Audit Reviewed with on Site

Safety Planning and Documentation

• Safety PTP captures all potential hazards and control measures

  Safe

  At Risk

  N/A

• Employees are utilizing control measures

  Safe

  Correction Needed

  N/A

• Safety PTP in place and all required personnel have signed.

  Safe

  Correction Needed

  N/A

• Equipment inspection forms in place as required (scissorlift, forklift, etc.)

  Safe

  Correction Needed

  N/A

• Confined space entry checklist and permit in place as required

  Safe

  Correction Needed

  N/A

• Hot Work Permit completed and in place

  Yes

  No

  N/A

• EEW Permit and/or MOP in place for work being performed as required

  Safe

  Correction Needed

  N/A

• OSHA Postings, SDS Binder, Grab & Go Binder, Clinic Maps in Place

  Yes

  No

  N/A

• Excavation/Trenching inspection in place and activity notification submitted if required

  Yes

  No

  N/A

Site Conditions

• Adequate site access/egress to project

  Safe

  Correction Needed

  N/A

• Required barricading/cones in place

  Yes

  No

  N/A

• Required signage/postings in place

  Yes

  No

  N/A

• Trash and debris contained/areas clean

  Safe

  Correction Needed

  N/A

• Material stored in safe/secure manner

  Safe

  Correction Needed

  N/A

• Shade & cool water readily available

  Safe

  Correction Needed

  N/A

• Slip/trip/fall hazards mitigated

  Safe

  Correction Needed

  N/A

• Dust controlled during activities generating dust

  Safe

  Correction Needed

  N/A

Positioning & Material Handling

• Material loading/unloading/movement

  Safe

  Correction Needed

  N/A

• Lifting Methods

  Safe

  Correction Needed

  N/A

• Line of fire/struck-by/caught in between

  Safe

  Correction Needed

  N/A

• Controls in place to mitigate risk from awkward postures, contact stress, repetitive motion, forceful motion, and vibration

  Safe

  Correction Needed

  N/A

Personal Protective Equipment & Tools/Equipment

• All required PPE Worn

  Safe

  Correction Needed

  N/A

• PPE available and in good condition

  Safe

  Correction Needed

  N/A

• Tools right for the job & used correctly

  Safe

  Correction Needed

  N/A

• Tools & equipment available/in good condition

  Safe

  Correction Needed

  N/A

• Equipment inspected (prior to use and/or required frequency)

  Safe

  At Risk

  N/A

• Recognitions

• Comments & Corrective Actions Taken